The Use of a Robotic Arm for Fixation of Pelvic Fractures

Abstract

Objectives: The objective of this study was to evaluate unplanned cortical or neuroforaminal violation of iliosacral and transsacral screw placement using fluoroscopy versus screw placement using a robotic arm. Design: This is a prospective cohort study. Setting: Single surgeon, single North American level 1 trauma center. Patients: Radiographic and clinical data for 21 consecutive adult trauma patients with pelvic ring fractures undergoing surgical treatment were prospectively collected. Treatment consisted of iliosacral and/or transsacral screws with or without anterior fixation. Intervention: Ten patients were treated with the assistance of a robotic arm. Eleven patients were treated with standard fluoroscopic techniques. Main Outcome Measurements: Thirty-two screws were placed and evaluated with postoperative computed tomography or O-arm spins to assess unplanned cortical or neuroforaminal violation. Violations were graded according to the Gertzbein and Robbins system for pedicle screw violation, categorizing screw violation in 2-mm increments. The postoperative images were blindly reviewed by 5 fellowship-trained orthopaedic traumatologists. The treating surgeon was excluded from review. Results: The Mann–Whitney U test on the Gertzbein and Robbins system results demonstrated significantly (P = 0.02) fewer violations with robotic assistance. χ2 analysis of whether there was a cortical violation of any distance demonstrated significantly (P = 0.003) fewer cortical violations with robotic assistance. There were no neurovascular injuries in either group. Conclusion: Robotic assistance demonstrated significantly fewer unplanned cortical or neuroforaminal violations. Further research is needed with additional surgeons and sites to evaluate the accuracy of iliosacral and transsacral screw placement with robotic assistance. Level of Evidence: Therapeutic, level II.